Telemetry¶
Ahmad Dbouk and Samuel Lazaroff
Background¶
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Many monitored pts do not have a true indication
- Leads to alarm fatigue, unnecessary workups, and is expensive
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Telemetry is not a substitute for more frequent vital signs
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Discuss frequently on rounds: always reassess need and indication
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Stable patients without troponin elevation or new arrythmias are typically appropriate for transfers without telemetry
| 0 | 1 |
|---|---|
| Clinical Scenario | Duration |
| Cardiac | Cardiac |
| ACS Post-MI | 24-48h 48h after revascularization |
| Vasospastic angina | Until symptoms resolve |
| Any event requiring ICD shocks | Remainder of hospitalization |
| New/unstable atrial tachyarrhythmias | Until stable on medical therapies |
| Chronic AF w/ recurrence of RVR | Clinical judgement |
| Ventricular tachyarrhythmias | Until definitive therapy |
| Symptomatic bradycardia | Until definitive therapy |
| Decompensated CHF | Until underlying cause treated |
| Procedural | Procedural |
| Ablation (regardless of co-morbidities) | 12-24h after procedure |
| Cardiac surgery | 48-72h, or until discharge if high risk for decompensation |
| Non-cardiac major surgery in patient with AF risk factors | Until discharge from step-down or ICU |
| Conscious sedation | Until patient awake, alert, HDS |
| Miscellaneous | Miscellaneous |
| Endocarditis | Until clinically stable |
| CVA | 24-48h |
| Electrolyte derangement (K, Mg) | Until normalization |
| Hemodialysis | Clinical judgement |
| Drug overdose | Until free of influence of substance |
Notable non-indications:
- PCI for non-ACS indication (i.e. pre-transplant), non-cardiac chest pain, Pt with AICD admitted for non-cardiac cause, non-cardiac surgery, chronic AF and clinically stable
- Contraindicated in hospice/comfort care
- Nearly all noncardiac conditions (i.e., undifferentiated sepsis, stable GI bleed, alcohol withdrawal) upon transfer out of ICU
Last update:
2022-06-21 14:41:42